 What is scoliosis and what causes it? Scoliosis is a term that's used to describe a curvature of the spine. The word itself is from an old Greek word that meant bent or crooked. It's describing a curvature of the spine that is three-dimensional in nature and it's usually found in kids who have some level of asymmetry or abnormal curvature of their back that is noticed by either the pediatrician or the parent early on in their early adolescence around the age of eight, nine or ten. And as we examine them and as we look a little further into it we find that their x-rays reveal a curvature of the spine. And the degree of a curvature is really what defines the challenges that scoliosis has in the medical community. What are the different types of scoliosis? Well, scoliosis itself is a definition that has been refined over time. There is the typical asymmetry in the spine that is found in many patients in the population. So for us the cut-off has always been ten degrees. Now that was an arbitrary decision made several decades ago but it has become a very helpful tool in examining the patient who is referred for scoliosis. Most patients with curvatures less than ten degrees aren't really considered to be at risk for worsening or progression of the scoliosis and don't really need any further work up. There are indeed several types of scoliosis. Most of them are defined by the age of onset or the cause of onset. So juvenile scoliosis or adolescent idiopathic scoliosis is pretty much determined by the age of onset of the scoliosis. Congenital scoliosis on the other hand is referring to an abnormality within the formation of the bone or the vertebra and that might be found or picked up on an exam earlier in presentation of the patient. And then there is adult scoliosis and then there is neuromuscular scoliosis often associated with either cerebral palsy or some of the other neuromuscular conditions. What causes scoliosis? The true cause of scoliosis is really unclear. What we know for sure is that certain medical conditions such as cerebral palsy and other neuromuscular conditions have a neurological scoliosis associated with them. But a great majority, more than 80% of scoliosis, don't have a really defined etiology or cause for that. What we've been able to determine is that there are multiple factors associated with scoliosis. Some of them are genetic, others are hormonal and we know that it's the interplay of all these different reasons that cause the curvature of the spine. If I have scoliosis, will my child get it? Very good question. What we know is that scoliosis has a multifactorial reason or factor and interplay that causes the curvature in the spine. That includes a genetic predisposition as well as some hormonal imbalances. And so while we are unable at this time to tell you what the percentage of descendants will get scoliosis, what we do know is that there is a close association usually within a first degree relative, meaning a parent or a sibling or so will have scoliosis. What in house scoliosis typically diagnosed? Scoliosis is usually picked up on routine surveillance or annual visit by the pediatrician. There are also other systems and mechanisms in play in our communities including school screening programs to pick up on these curvatures. What we've learned is that any time the occasion arises, whether it's a parent that has noticed an abnormal curvature or whether it's a pediatrician that is picked up on some asymmetry, we ought to take a look. And that means at least getting an x-ray, at least doing a good physical exam from top to bottom, examining the patient for any other associations that are also related to scoliosis including neuromuscular diseases and other syndromes that are associated with scoliosis. A good physical exam oftentimes can help you cone in on the etiology and what kind of expectations you may have from the x-ray findings and maybe the true cause of the scoliosis. Why is early intervention so important with patients with scoliosis? The challenge with taking care of patients with scoliosis is to be able to prevent the progression of the curvature of the spine. And usually this happens during the growth spurt. As the patient grows in height, there's a higher likelihood of the curvature getting worse. With that, we try to observe and follow the degree of curvature over time and if they meet the criteria for bracing, which is usually between 25 degrees to 40 degrees, we try to jump early on to that and brace them so that we can stop the progression to more severe angles that require further treatment. What changes should be made to lifestyle when someone is diagnosed with scoliosis? Very good question. That really depends on how much pain the patient has. Oftentimes when the patient and the family is diagnosed with scoliosis, they like to know what type of exercises or activities they should avoid or potentially do to help reduce the extent of the curvature of the spine. And the truth is, no activity or no sleeping pattern has been shown to worsen the curvature of the spine. It all comes back to whether the patient has pain or not. If the patient has pain, we do often look a little further because most scoliosis doesn't cause pain. It may warrant a further workup such as an MRI or maybe genetic testing or other types of workups. However, if the patient isn't having any pain, they can sleep and participate in any activities in any form that they want as long as they are comfortable. It hasn't been shown to worsen the extent of the curvature of the spine at all. What treatments are available for scoliosis? Will everyone diagnosed with scoliosis require surgery? There are various treatment options for scoliosis and it really depends on what kind of scoliosis you are dealing with. If it is congenital scoliosis, it oftentimes does need an intervention over many years to make sure there is symmetrical growth in the spine and that there aren't any long-term effects such as respiratory complications that may affect the patient. If we're dealing with adolescent idiopathic scoliosis, what we'd like to do is to be able to jump on early so that we can diagnose the patient and if the patient needs bracing, we start early. So bracing is one of the more preferable, non-invasive forms of treatment for scoliosis. A majority of our patients are observed and that's all they really need just to make sure that there's no progressive changes to the scoliosis. However, there is a certain percentage that requires surgical treatment. Most of the current studies do show that curvature over 45 degrees do need to be attended to and usually that means spinal fusion. Now, the purpose of spinal fusion is usually not to completely correct the spinal curvature but rather to stop the progression. So we can usually expect somewhere close to 50% correction of the curvature but what we'd like to do is stop the progression as the patient grows older. Are people able to return to normal activity after scoliosis treatment? That depends on the treatment. If the patient is currently being braced for their scoliosis, all that really means is that they need to meet a criteria of hours per day in the brace. Studies show now that 18 hours a day is sufficient to stop the progression of this curvature. So if they can get 18 hours per day and that includes time spent sleeping in the brace overnight, they can take off their brace as they need to for their different activities ranging from gymnastics to swimming to football. Now, for those that undergo spinal fusion, the goal of surgery would be to get them back to their activities. However, it will take some time. The surgeon does indeed need to do some interval follow-up to make sure that spinal fusion actually has been achieved but eventually the goal would be to get them back to all the activities that they're used to doing and that could take up to six months of follow-up. What are the goals and expectations of scoliosis surgery? How much correction would you expect to achieve? While the goals of bracing really are to stop the progression of the curvature of the spine, the goals of surgical spinal fusion can include not only stopping the progression of the curvature but to correct some of the deformity. And that really depends on the degree of the curvature to begin with because unfortunately some of these curvatures can impact the development of the lungs and the heart. So some of the correction that you can achieve during surgery may help the development of these very important organs. As far as the degree of correction, it really depends on the severity of the curvature but what we tell our patients is that they can expect at least a 50% correction and the magnitude of the curvature. For more information about scoliosis cure here at NYU Winthrop Hospital please call us at 866 Winthrop or visit us online at nyuwinthrop.org